<form name="frmAddMyCtv" id="frmAddMyCtv">
    <table cellpadding="0" cellspacing="0" width="100%" class="table-form-post">
        <col width="20%">
        <col width="80%">
        
        <tr>
            <td>
                Tên đầy đủ
            </td>
            <td>
                <input class="w200p" type="text" id="customer_full_name" name="customer_full_name" ><span id="customer_full_name_error" class="validate_error" style="display: none;"></span>
            </td>
        </tr>
        <tr>
            <td>
                Tên đăng nhập
            </td>
            <td>
                <input class="w200p" type="text" id="customer_user_name" name="customer_user_name"><span id="customer_user_name_error" class="validate_error" style="display: none;"></span>
            </td>

        </tr>
        <tr>
            <td>
                Mật khẩu
            </td>
            <td>
                <input class="w200p" type="password" id="customer_password" name="customer_password"><span id="customer_password_error" class="validate_error" style="display: none;"></span>
            </td>
        </tr>
        <tr>
            <td>
                Nhập lại mật khẩu
            </td>
            <td>
                <input class="w200p" type="password" id="repassword" name="repassword"><span id="repassword_error" class="validate_error" style="display: none;"></span>
            </td>
        </tr>
        <tr>
            <td>
                Email
            </td>
            <td>
                <input class="w200p" type="text" id="customer_email" name="customer_email"><span id="customer_email_error" class="validate_error" style="display: none;"></span>
            </td>

        </tr>
        <tr>
            <td>
                Địa phương
            </td>
            <td>
                <select name="customer_zone_id" id="customer_zone_id" style="width: 218px;">
                    <option value="">Chọn tỉnh/TP</option>
                    <?php foreach ($aryLocation as $key => $value) {?>
                        <option value="<?php echo $value['location_id'];?>"><?php echo $value['location_name'];?></option>
                    <?php } ?>
                </select>
                <span id="customer_zone_id_error" class="validate_error" style="display: none;"></span>
            </td>

        </tr>
        <tr>
            <td>
                Điện thoại di động
            </td>
            <td>
                <input class="w200p" type="text" id="customer_mobile_phone" name="customer_mobile_phone"><span id="customer_mobile_phone_error" class="validate_error" style="display: none;"></span>
            </td>
        </tr>
        <tr>
            <td>
                Điện thoại cố định
            </td>
            <td>
                <input class="w200p" type="text" id="customer_home_phone" name="customer_home_phone"><span id="customer_home_phone_error" class="validate_error" style="display: none;"></span>
            </td>
        </tr>
        <tr>
            <td>
                Nick yahoo
            </td>
            <td>
                <input class="w200p" type="text" id="customer_yahoo" name="customer_yahoo" ><span id="customer_yahoo_error" class="validate_error" style="display: none;"></span>
            </td>

        </tr>
        <tr>
            <td>
                Nick skype
            </td>
            <td>
                <input class="w200p" type="text" id="customer_skype" name="customer_skype"><span id="customer_skype_error" class="validate_error" style="display: none;"></span>
            </td>
        </tr>
        <tr>
            <td>
                Địa chỉ
            </td>
            <td>
                <input class="w200p" type="text" id="customer_address" name="customer_address"><span id="customer_address_error" class="validate_error" style="display: none;"></span>
            </td>
        </tr>
        <tr>
            <td>
                Ngày sinh
            </td>
            <td>
                <select tooltiptext="Vui lòng chọn ngày sinh." id="day" name="day" style="width: 70px;">
                        <option value="">Ngày</option>
                        <option value="1">1</option><option value="2">2</option><option value="3">3</option><option value="4">4</option><option value="5">5</option><option value="6">6</option><option value="7">7</option><option value="8">8</option><option value="9">9</option><option value="10">10</option><option value="11">11</option><option value="12">12</option><option value="13">13</option><option value="14">14</option><option value="15">15</option><option value="16">16</option><option value="17">17</option><option value="18">18</option><option value="19">19</option><option value="20">20</option><option value="21">21</option><option value="22">22</option><option value="23">23</option><option value="24">24</option><option value="25">25</option><option value="26">26</option><option value="27">27</option><option value="28">28</option><option value="29">29</option><option value="30">30</option><option value="31">31</option>
                </select>
                <select id="month" name="month" style="width: 70px;">
                        <option value="">Tháng</option>
                        <option value="1">1</option><option value="2">2</option><option value="3">3</option><option value="4">4</option><option value="5">5</option><option value="6">6</option><option value="7">7</option><option value="8">8</option><option value="9">9</option><option value="10">10</option><option value="11">11</option><option value="12">12</option>
                </select>
                <select id="year" name="year" style="width: 70px;">
                        <option value="">Năm</option>
                        <option value="2011">2011</option><option value="2010">2010</option><option value="2009">2009</option><option value="2008">2008</option><option value="2007">2007</option><option value="2006">2006</option><option value="2005">2005</option><option value="2004">2004</option><option value="2003">2003</option><option value="2002">2002</option><option value="2001">2001</option><option value="2000">2000</option><option value="1999">1999</option><option value="1998">1998</option><option value="1997">1997</option><option value="1996">1996</option><option value="1995">1995</option><option value="1994">1994</option><option value="1993">1993</option><option value="1992">1992</option><option value="1991">1991</option><option value="1990">1990</option><option value="1989">1989</option><option value="1988">1988</option><option value="1987">1987</option><option value="1986">1986</option><option value="1985">1985</option><option value="1984">1984</option><option value="1983">1983</option><option value="1982">1982</option><option value="1981">1981</option><option value="1980">1980</option><option value="1979">1979</option><option value="1978">1978</option><option value="1977">1977</option><option value="1976">1976</option><option value="1975">1975</option><option value="1974">1974</option><option value="1973">1973</option><option value="1972">1972</option><option value="1971">1971</option><option value="1970">1970</option><option value="1969">1969</option><option value="1968">1968</option><option value="1967">1967</option><option value="1966">1966</option><option value="1965">1965</option><option value="1964">1964</option><option value="1963">1963</option><option value="1962">1962</option><option value="1961">1961</option><option value="1960">1960</option><option value="1959">1959</option><option value="1958">1958</option><option value="1957">1957</option><option value="1956">1956</option><option value="1955">1955</option><option value="1954">1954</option><option value="1953">1953</option><option value="1952">1952</option><option value="1951">1951</option><option value="1950">1950</option><option value="1949">1949</option><option value="1948">1948</option><option value="1947">1947</option><option value="1946">1946</option><option value="1945">1945</option><option value="1944">1944</option><option value="1943">1943</option><option value="1942">1942</option><option value="1941">1941</option><option value="1940">1940</option><option value="1939">1939</option><option value="1938">1938</option><option value="1937">1937</option><option value="1936">1936</option><option value="1935">1935</option><option value="1934">1934</option><option value="1933">1933</option><option value="1932">1932</option><option value="1931">1931</option><option value="1930">1930</option><option value="1929">1929</option><option value="1928">1928</option><option value="1927">1927</option><option value="1926">1926</option><option value="1925">1925</option><option value="1924">1924</option><option value="1923">1923</option><option value="1922">1922</option><option value="1921">1921</option><option value="1920">1920</option>
                </select>
                <span id="customer_birthday_error" class="validate_error" style="display: none;"></span>
            </td>
        </tr>
        <tr>
            <td>
                Giới tính
            </td>
            <td>
                    <input type="radio" name="customer_gender" value="1" class="radio-sex" checked="checked">
                        Nam&nbsp;&nbsp;&nbsp;
                    <input type="radio" name="customer_gender" value="2" class="radio-sex">Nữ
            </td>

        </tr>
        <tr>
            <td>
                Số tài khoản NH
            </td>
            <td>
                <input type="text" name="customer_bank_number" id="customer_bank_number" class="w200p">
                <span id="customer_bank_number_error" class="validate_error" style="display: none;"></span>
            </td>
        </tr>
        <tr>
            <td>
                Tên ngân hàng
            </td>
            <td>
                <input type="text" name="customer_bank_name" id="customer_bank_name" class="w200p">
            </td>
        </tr>
        <tr>
            <td colspan="2">
                <input type="button" name="btnAddMyCtv" id="btnAddMyCtv" class="submit" value="Thêm CTV" onclick="AdminController.saveMyCtv();">
            </td>
        </tr>

    </table>
    
</form>